NOSE, NASAL CAVITY AND PARANASAL SINUSES

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1 NOSE, NASAL CAVITY AND PARANASAL SINUSES

2 EXTERNAL NOSE: Pyramidal Root Apex External nares or nostrils Dorsum nasi Alae nasi

3 SKELETON BONY FRAMEWORK CARTILAGINOUS FRAMEWORK BONES: nasal bones frontal process of maxilla nasal part of frontal bone CARTILAGES septal lateral nasal major and minor alar

4 Vessels and nerves- external nose Arteries : Facial artery- alar, septal branch Ophthalmic artery-dorsal nasal branch Maxillary artery- infraorbital branch Veins :Facial, ophthalmic veins Nerves: motor : buccal branch of facial sensory : ophthalmic- infratrochlear branch nasociliary external nasal branch infraorbital- nasal branch

5 NASAL CAVITY halves- nasal septum External nares cm cm posterior nasal apertures (choanae) 2.5 by 1.3 cm each half- roof floor medial wall lateral wall three regions- vestibule respiratory region olfactory region

6 NASAL SEPTUM Anterior - septal cartilage Vomer Perpendicular plate of ethmoid Minor contributions- nasal, frontal, sphenoid, maxilla, palatine bones Often deflected

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8 LATERAL WALL- bones Maxilla- anteroinferiorly Perpendicular plate of palatine Ethmoid labyrinth- superiorly Other bones- nasal, frontal process of maxilla, lacrimal Irregular- three conchae Superior concha- shortest, shallowest Middle concha- large, articulates with palatine On removal ethmoidal bulla, uncinate process, ethmoid Inferior concha- independent bone, articulates with maxilla Concha suprema sphenopalatine foramen

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11 LATERAL WALL Corresponding meatuses Sphenoethmoidal recess Superior meatus- posterior ethmoidal cells Middle meatus- continues atrium of middle meatus, Features- bulla ethmoidalis, hiatus semilunaris, ethmoidal infundibulum Openings of sinuses- anterior and middle ethmoidal, frontal, maxillary Inferior meatus- nasolacrimal duct

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13 NASAL ROOF AND FLOOR Roof Sphenoidal, ethmoidal and frontonasal regions Floor Transversely concave Palatine pr. Maxilla Horizontal part- palatine bone

14 VESSELS OF NASAL CAVITY SEPTUM Anterior, posterior ethmoidal art. Br ophthalmic art. Sphenopalatine br. Maxillary art. Greater palatine br. Maxillary art. Septal br. Facial art. LATERAL WALL Anterior, posterior ethmoidal art. Sphenopalatine art. Lateral nasal br. Facial art. Greater palatine art. VEINS Sphenopalatine v, facial v, ophthalmic v LYMPHATIC DRAINAGE Submandibular nodes Upper deep cervical

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17 NERVES SEPTUM Anterior ethmoidal br. Nasociliary Nasal br. Infraorbital Anterior superior alveolar br. Maxillary Medial posterior superior nasal br. Of pterygopalatine gang. LATERAL WALL Anterior ethmoidal br Anterior superior alveolar br lateral posterior superior nasal br. Of pterygopalatine gang. OLFACTORY NERVE AUTONOMIC Sympathetic postganglionic vasomotor Parasympathetic postganglionic pterygopalatine gang. nasal gl.

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20 i c h Oval openings between nasal cavities and nasopharynx h rigid openings completely surrounded by bone a v inferiorly, by the posterior border of the horizontal e plate of the palatine bone; Posterior nares (chonae) f laterally, by the posterior margin of the medial plate l of the pterygoid process; e x medially, by the posterior border of the vomer. i b The roof of the choanae is formed: l anteriorly by the ala of the vomer and the vaginal e process of the medial plate of the pterygoid process; posteriorly by the body of the sphenoid bone. b o r d e r s

21 Gateways Cribriform plate Sphenopalatine foramen Incisive canal Small foramina in the lateral wall

22 Arterial supply

23 Venous drainage

24 Nerve supply

25 PARANASAL SINUSES The paranasal sinuses develop as outgrowths from the nasal cavities and erode into the surrounding bones. All are: lined by respiratory mucosa, which is ciliated and mucus secreting; open into the nasal cavities; innervated by branches of the trigeminal nerve [V]. bilateral paired frontal maxillary ethmoidal (anterior, middle, posterior groups) sphenoidal Sinuses absent or rudimentary at birth

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27 FRONTAL SINUS posterior to superciliary arches Prominent in males Rarely symmetrical L=3.2cm, b=2.6 cm,h=1.8 cm Incomplete septa- recesses Opening- ethmoidal infundibulum or frontonasal duct Arterial supply: supraorbital, anterior ethmoidal Nerve supply: supraorbital Lymphatic drainage: submandibular nodes

28 ETHMOIDAL SINUSES Thin walled cavities in ethmoidal labyrinth 3 large to 18 small sinuses Location- upper nasal cavity and orbit Anterior group (infundibular ) 11, open at infundibulum Middle group: (bullar sinuses) usually 3, open on / above ethmoidal bulla Posterior group : 1-7 in no. open in superior meatus Arterial supply: sphenopalatine, anterior, posterior ethmoidal art. Lymphatic drainage: ant, middle group- submandibular nodes, post groupretropharygeal nodes Nerves: anterior, posterior ethmoidal nerves, orbital branches of pterygopalatine gang.

29 SPHENOIDAL SINUS Paired, in body of sphenoid Relations: above to the cranial cavity, particularly to the pituitary gland and to the optic chiasma; laterally, to the cranial cavity, particularly to the cavernous sinuses; below and in front, to the nasal cavities. H=2 cm, b=1.8 cm, d=2.1cm Opens at spenoethmoidal recess Arterial supply: posterior ethmoidal art. Lymphatic drainage: retropharyngeal nodes Nerve supply: post. Ethmoidal nerves, orbital br

30 MAXILLARY SINUS Paired, body of maxilla Pyramidal- base, apex, roof, floor Relations: superolateral surface (roof) is related above to the orbit; anterolateral surface is related below to the roots of the upper molar and premolar teeth and in front to the face; posterior wall is related behind to the infratemporal fossa. Conical elevations- roots molar teeth H=3.5cm, b=2.5cm, d=3.2cm Opens hiatus semilunaris Blood vessels: facial, greater palatine, infraorbital vessels Lymphatic drainage: submandibular nodes Nerve supply: infraorbital, ant., middle and post. Superior alveolar nerves

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32 Pterygo-palatine fossa the middle cranial fossa; infratemporal fossa; floor of the orbit; lateral wall of the nasal cavity; oropharynx; roof of the oral cavity

33 Pterygo-palatine fossa the foramen rotundum and pterygoid canal communicate with the middle cranial fossa and open onto the posterior wall; a small palatovaginal canal opens onto the posterior wall and leads to the nasopharynx; the palatine canal leads to the roof of the oral cavity (hard palate) and opens inferiorly; the sphenopalatine foramen opens onto the lateral wall of the nasal cavity and is in the medial wall; the lateral aspect of the pterygopalatine fossa is continuous with the infratemporal fossa via a large gap (the pterygomaxillary fissure) between the posterior surface of the maxilla and pterygoid process of the sphenoid bone; the superior aspect of the anterior wall of the fossa opens into the floor of the orbit via the inferior orbital fissure

34 Pterygopalatine ganglion Peripheral parasymp. Ganglion Sensory Parasympathetic Sympathetic Branches: Orbital Greater and lesser palatine nerves Pharyngeal Nasal Zygomatic

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36 Applied Anatomy Nasal fractures Deviation of the nasal septum Rhinitis Epistaxis Sinusitis: Frontal Ethmoidal air cells Maxillary sphenoidal Transillumintion of sinuses

37 Because only thin shelves of bone separate the sphenoidal sinuses from the nasal cavities below and hypophyseal fossa above, the pituitary gland can be surgically approached through the roof of the nasal cavities by passing first through the anteroinferior aspect of the sphenoid bone and into the sphenoidal sinuses and then through the top of the sphenoid bone into the hypophyseal fossa.